Active NPI
Justina M Breseno, MD
- Pediatrics Physician
- Riverside, CA
National Provider Identifier
1558454355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A50599
- Practice address
- 6485 Day St
Suite 103
Riverside, CA 92507-0929 - Phone
- (714) 777-2593
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A50599 | CA | Primary |
Addresses
Primary practice location
6485 Day St
Suite 103
Riverside, CA 92507-0929
Mailing address
20365 Shakari Circle
Yorba Linda, CA 92887
Phone (951) 601-6802
Other names 1
- Justina Robles Martin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50599 | CA | MD | Marriage & Family Therapist |
| A50599 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558454355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20365 SHAKARI CIRCLE",
"city": "YORBA LINDA",
"state": "CA",
"postal_code": "92887",
"telephone_number": "951-601-6802",
"fax_number": "951-604-9263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6485 DAY ST",
"address_2": "SUITE 103",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925070929",
"telephone_number": "714-777-2593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRESENO",
"first_name": "JUSTINA",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A50599",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JUSTINA",
"last_name": "MARTIN",
"middle_name": "ROBLES",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.